Admin/Clerical - Pharmacy Specialist Level 1 Pharmacy Specialist Level 1
Company: Axelon Services Corporation
Location: Newark
Posted on: January 26, 2023
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Job Description:
Job Description: Job Summary:
This position is responsible for receiving verbal and written
requests for prior authorization from pharmacists, physicians
and/or patients and is responsible for supporting and assisting in
the coordination of Pharmacy Services activities including claim
utilization analysis, prescription plan design, ad-hoc reporting,
correspondence and special projects. Must maintain performance in
compliance with organizational or department goals and in
compliance with regulatory agencies
Responsibilities:
Process prior authorizations received via prior authorization help
line, by evaluating the medical necessity/appropriateness for
specific drugs and based on medical criteria.
- Directly interact with members physician office staff, pharmacies
and internal stake holders for eligibility, coverage determination
claims issues.
- Conduct intervention with physician & pharmacy office staff to
facilitate formulary compliance and generic dispensing.
- Process appeals complaints executive inquiries and compliance
related issues.
- Provide recommendations to increase efficiency, accuracy and
productivity in the department.
- Process ad hoc request for information or reports from
stakeholders.
- Participate in client member and employee training to ensure
practical understanding of pharmacy services programs and
operations.
- Assist in the day to day business functions of the pharmacy
department as well as the Medication Therapy Management
program.
- Provide support to various clinical programs within the pharmacy
department.
Education/Experience:
- Prefers a Bachelor's degree from an accredited college or
university in Health Care Management, Business or Pharmaceutical
Administration.
- Requires minimum of two (2) years experience in third party
prescription program claim adjudication.
- Requires minimum of two (2) years experience as a Pharmacy
Utilization Management Specialist.
- Requires prior customer service/service quality initiative
experience.
Keywords: Axelon Services Corporation, Newark , Admin/Clerical - Pharmacy Specialist Level 1 Pharmacy Specialist Level 1, Healthcare , Newark, New Jersey
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